Risk factors and outcomes for ineffective empiric treatment of sepsis caused by gram-negative pathogens: Stratification by onset of infection

ABSTRACT Sepsis and septic shock remain serious consequences of infections, with reported mortality rates in excess of 40 percent. Timely antibiotic therapy in cases of sepsis and septic shock is recognized as an important determinant of outcome. However, the administration of ineffective empirical treatment (IET) (an initial antibiotic regimen that is not active against the identified pathogen[s] based on in vitro susceptibility testing results) is associated with excess mortality compared to effective empirical treatment (EET). We examined all hospitalized patients at Barnes-Jewish Hospital with a sterile site (blood or pleural, abdominal, cerebrospinal, synovial, and pericardial fluid) culture positive for Gram-negative (GN) bacteria combined with a primary or secondary ICD-9-CM code for severe sepsis (995.92) or septic shock (785.52) between January 2010 and October 2015. Variables significantly associated with early-onset (&lt;48 h of hospitalization) IET of GN sterile site sepsis and septic shock included age, recent hospitalization, and prior intravenous antibiotics. Late-onset IET was associated with increasing numbers of hospitalization days before infection onset and prior intravenous antibiotic administration. For patients with early-onset infection, we found no difference in rates of survival between patients receiving IET and EET. However, patients in the late-onset infection group receiving IET had a statistically lower rate of survival than those receiving EET. These data suggest that risk factors and outcomes for IET can vary based on the time of onset of infection. Our results also highlight the importance of prior intravenous antibiotic exposure as a risk factor for IET in infections by GN bacteria regardless of the time of onset of infection. </jats:p

Thinking intuitively: the rich (and at times illogical) world of concepts

Intuitive knowledge of the world involves knowing what kinds of things have which properties. We express it in generalities such as “ducks lay eggs”. It contrasts with extensional knowledge about actual individuals in the world, which we express in quantified statements such as “All US Presidents are male”. Reasoning based on this intuitive knowledge, while highly fluent and plausible may in fact lead us into logical fallacy. Several lines of research point to our conceptual memory as the source of this logical failure. We represent concepts with prototypical properties, judging likelihood and argument strength on the basis of similarity between ideas. Evidence that our minds represent the world in this intuitive way can be seen in a range of phenomena, including how people interpret logical connectives applied to everyday concepts, studies of creativity and emergence in conceptual combination, and demonstrations of the logically inconsistent beliefs that people express in their everyday language

Coming to Peace in the Presence of Wild Things: A Personal Exploration of the Intersections of the Environment and Faith

From a young age, I have felt the power that certain places have over me. Some made me feel an overwhelming sense of awe, some freedom, and some made me feel depths of peace unknown like Wendell Berry describes in the poem above. Considering my natural restlessness, a disposition that has been there since birth, the fact these places invoke a feeling of peace that washes over me speaks volumes to their power. It wasn’t until college that I truly recognized this power of place, but since learning that fact I have sought its connection. A professor of mine gave me the language to describe this power that place has on me— he called these places “thin spaces.” These thin spaces, he told me, were where ancient Celts believed the boundary between the physical world we inhabit, and the spirit(ual) world is thin—. In some of these thin spaces, I believe the line is blurred, or non-existent altogether. It is as if the place inhabits both realms giving us a genuine look into what the world beyond our own is like. This project will be an introduction to and exploration of these thin spaces that I have encountered in my time on Earth. I hope that in my story, these places\u27 power will come through the pages and blur that line between worlds

Interaction of point sources and vortices for incompressible planar fluids

We consider a new system of differential equations which is at the same time gradient and locally Hamiltonian. It is obtained by just replacing a factor in the equations of interaction for N point vortices, and it is interpreted as an interaction of N point sources. Because of the local Hamiltonian structure and the symmetries it obeys, it does possess some of the first integrals that appear in the N vortex problem. We will show that binary collisions are easily blown up in this case since the equations of motion are of first order. This method may be easily generalized to the blow up of higher order collisions. We then generalize the model further to interactions of sources and vortices.Comment: 9 page

The Guppy Effect as Interference

People use conjunctions and disjunctions of concepts in ways that violate the rules of classical logic, such as the law of compositionality. Specifically, they overextend conjunctions of concepts, a phenomenon referred to as the Guppy Effect. We build on previous efforts to develop a quantum model that explains the Guppy Effect in terms of interference. Using a well-studied data set with 16 exemplars that exhibit the Guppy Effect, we developed a 17-dimensional complex Hilbert space H that models the data and demonstrates the relationship between overextension and interference. We view the interference effect as, not a logical fallacy on the conjunction, but a signal that out of the two constituent concepts, a new concept has emerged.Comment: 10 page

Factors influencing the emergence of suborbital space tourism

Suborbital space tourism is becoming a reality. The suborbital space industry is predicted to grow from $340 billion to$1 trillion over the next 20 years. A literature review, conducted on references from 2012 to 2019, identified five factors associated with the development and management of safe and effective suborbital space tourism. This paper summarizes the aspects of demand, ticket cost, motivation and risk, health risk, and policy, and how each influences the development and management of suborbital space toursim

Estimating the diameter of the left main bronchus

Publisher's copy made available with the permission of the publisherTwo hundred and six standard PA chest X-rays were measured. The mean diameter of the left main bronchus (LMB) was 12.6±1.9 mm. The mean diameter of the 92 male LMB was 13.0±2.6, and for females 11.8±1.6. These data correspond closely to that reported by others. The correlation between the diameter of the LMB and that of the trachea was 0.74 but was not precise enough to be useful as an estimate for clinical use. Similarly there was good correlation between the diameter of the right main bronchus and that of the left (r=0.75) but not precise enough to be clinically useful. In contrast to previous claims, only direct measurement of the left main bronchus has sufficient precision to define the appropriate size of left double-lumen tube to be selected for lung separation.T. Hampton, S. Armstrong, W.J. Russellhttp://www.aaic.net.au/Article.asp?D=200003

Pruning Algorithms for Pretropisms of Newton Polytopes

Pretropisms are candidates for the leading exponents of Puiseux series that represent solutions of polynomial systems. To find pretropisms, we propose an exact gift wrapping algorithm to prune the tree of edges of a tuple of Newton polytopes. We prefer exact arithmetic not only because of the exact input and the degrees of the output, but because of the often unpredictable growth of the coordinates in the face normals, even for polytopes in generic position. We provide experimental results with our preliminary implementation in Sage that compare favorably with the pruning method that relies only on cone intersections.Comment: exact, gift wrapping, Newton polytope, pretropism, tree pruning, accepted for presentation at Computer Algebra in Scientific Computing, CASC 201

Defamation Per Se and Transgender Status: When Macro-Level Value Judgments About Equality Trump Micro-Level Reputational Injury

This Article uses the September 2017 defamation decision in Simmons v. American Media, Inc. as a springboard for examining defamatory meaning and reputational injury. Specifically, it focuses on cases in which judges acknowledge that plaintiffs have suffered reputational harm yet rule for defendants because promoting the cultural value of equality weighs against redress. In Simmons, a normative, axiological judgment--that the law should neither sanction nor ratify prejudicial views about transgender individuals-- prevailed at the trial court level over a celebrity\u27s ability to recover for alleged reputational harm. Simmons sits at a dangerous intersection: a crossroads where a noble judicial desire to reject prejudicial stereotypes and to embrace equality collides head-on with an ignoble reality in which a significant minority of the population finds a particular false allegation (in Simmons, transgender status) to be defamatory. This Article examines how courts historically determined defamatory meaning and how once-defamatory per se statements about sexual orientation are not always considered so today. When viewed beyond a legal lens, however, research suggests transgender individuals have not witnessed the same benefits of that altered perspective. There is a key difference between attitudes about sexual orientation and attitudes about sexual identity. The Article concludes by proposing variables for courts to apply in future cases where a dispute exists over whether an allegation is defamatory per se, rather than leaving the decision to the discretion of judges untethered from formal criteria